BILL NUMBER: SJR 30	CHAPTERED  09/20/00

	RESOLUTION CHAPTER   162
	FILED WITH SECRETARY OF STATE   SEPTEMBER 20, 2000
	ADOPTED IN SENATE   AUGUST 31, 2000
	ADOPTED IN ASSEMBLY   AUGUST 23, 2000
	AMENDED IN ASSEMBLY   JULY 6, 2000
	AMENDED IN SENATE   MAY 11, 2000

INTRODUCED BY   Senator Speier
   (Coauthors:  Assembly Members Aroner and Mazzoni)

                        APRIL 5, 2000

   Senate Joint Resolution No. 30--Relative to the federal Pain
Relief Promotion Act.


	LEGISLATIVE COUNSEL'S DIGEST


   SJR 30, Speier.  Federal Pain Relief Promotion Act.
   This measure would urge the defeat by Congress or the veto of the
President of the proposed federal Pain Relief Promotion Act.




   WHEREAS, Proposed legislation pending in Congress, entitled the
Pain Relief Promotion Act of 1999 (PRPA) (H.R. 2260), would
substantially increase the investigatory and penalty powers of the
government in a crucial area of medical practice; and
   WHEREAS, The PRPA would place doctors at risk of license
revocation and incarceration for prescribing pain medication; and
prosecutions would be based on the evaluation of acceptable
palliative care and of the doctors' subjective intentions by Drug
Enforcement Administration officials who lack medical expertise; and
   WHEREAS, Multiple comprehensive studies have indicated that as
many as half of all Americans spend their final days enduring
undertreated pain, and American medicine has only begun to mount a
concerted effort to improve pain relief nationwide; and
   WHEREAS, Physicians who care for terminally ill patients need to
try different approaches in prescribing pain medication in their
efforts to alleviate intolerable suffering at the end of life; and
   WHEREAS, The PRPA's punitive provisions will discourage doctors
from prescribing or administering adequate doses of medication to
relieve the pain of dying patients, for fear of loss of license and
criminal prosecution; and
   WHEREAS, Numerous state medical associations and physicians with
expertise in end-of-life care oppose PRPA, and the nation's leading
medical journal, the New England Journal of Medicine, strongly
condemns the PRPA; and
   WHEREAS, The editor of the New England Journal of Medicine has
stated that if the PRPA becomes law "Congress will have done great
harm to dying patients and to their physicians, who should be able to
offer compassionate care without the fear of reprisal"; and
   WHEREAS, Writing in other prestigious journals, such as the
Journal of the American Medical Association and the Western Journal
of Medicine, which are the official journals of the American Medical
Association and California Medical Association, have echoed those
concerns in opposing the PRPA; and
   WHEREAS, the PRPA acknowledges that providing a controlled
substance for palliative care, even if it hastens death, is
legitimate medical care.  It defines that care, however, within the
context of physician-assisted suicide and consideration regarding a
physician's intent.  Consequently, the bill inappropriately expands
DEA authority to evaluate the practice of medicine as it pertains to
pain management.  DEA will be required to interpret a physician's
intent as it applies to prescribing controlled substances for pain in
determining whether a physician should be registered under the
Controlled Substances ACT (CSA).  The Department of Justice and DEA
have recently rejected that type of subjective decisionmaking on the
part of the agency in issues related to pain management.  The PRPA
does not improve the standards for palliative care and may make
physicians hesitant to prescribe controlled substances in treatment
of severe pain for fear of the potential criminal, civil, and
administrative penalties; and
   WHEREAS, the relevant law and the courts recognize the legitimacy
of prescribing controlled substances for palliative care.  The CSA
and DEA regulations provide that physicians have an obligation to
treat those suffering from intractable pain.  The CSA states that
many controlled substances have a "useful and legitimate medical
purpose and are necessary to maintain the health and general welfare
of the American people" (21 U.S.C.A.  Section 801(1); and
   WHEREAS, even where the CSA requires a special registration for
prescribing controlled substances for additional treatment, DEA
regulations state that there is no intent to limit a physician's
ability to prescribe for intractable pain (21 C.F.R. Section
1306.07).  The United States Supreme Court has also recognized that
patients suffering from a terminal illness have a right to palliative
care even if it hastens death (Glucksberg v.  Washington (1997) 521
U.S. 702; Quill v. Vacco (1997) 521 U.S. 793).  Therefore, there is
no ambiguity in the law or DEA policy as to whether prescribing a
controlled substance for pain management is appropriate medical care,
even in large doses where necessary.
   WHEREAS, The PRPA raises serious concerns about federal
infringement of states' rights; now, therefore, be it
   Resolved by the Senate and Assembly of the State of California,
jointly, That the Legislature of the State of California respectfully
urges the Congress of the United States to defeat the PRPA, and the
President of the United States to veto the PRPA if Congress passes
this bill; and be it further
   Resolved, That the Secretary of the Senate transmit copies of this
resolution to the President and Vice President of the United States,
to the Speaker of the House of Representatives, and to each Senator
and Representative from California in the Congress of the United
States.
